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Insomnia

DEFINTION-

It is sleep disorder characterised by difficulty in falling and remaining asleep, early morning awaking, frequent awaking during night, lack of restful sleep. OR a combination of all the above mentioned things.

It can be a primary disorder OR it can be a secondary manifestation of psychiatric illness, anxiety, and drug use for sleep apnea.

History of the patient may determine whether sleep is disturbed by irregular sleep schedule and waking up time, afternoon nap,excessive night time noise, heat, self medication, consumption of alcohol, caffeine and tobacco.

CAUSES-

Insomnia is a disorder in which one though sleepy is unable to sleep or remains abnormally awake at night.
So instead of sedating the patient if one tries to find out the cause of Insomnia and treat it the effect would be positively safe and long lasting.

Causes of Insomnia can be divided into 2 categories. They are

A] Physical -

In cases of severe pain
Breathlessness
Heat or fever
Cerebral diseases
Old age

B] Mental -

Anxiety fear
Mental exhaustion
Nervous excitement
Excessive worry
Depression

SYMPTOMS-

1) Difficulty in falling asleep.
2) Waking up early morning.Patient is unable to get back to sleep.
3) Restless, disturbed sleep &frequent awakening.
4) Associated symptoms like anxiety, depression, alcoholism, drug abuse.
5) Sleep walking
6) Waking up unrefreshed.

COMPLICATIONS-

Lethargy
Heaviness in body
Burning of eyes
Loss of interest
Loss of appetite
Constipation
Headache

TREATMENT-

Treat the underlying condition like pain.

Avoid drinking alcohol, tea, coffee, late in the evening.

Decrease smoking & overeating

Do light exercise before going to bed (simple walking around 100 steps would be beneficial.)

Behaviour modification, relaxation techniques and psychological counselling

Drug therapy depending on the cause.

If anxiety is the cause anti-anxiety drug.

If depression is the cause anti-depressants.

Short acting sleep inducers.

Sleep maintainers for prolonged disturbances.

If at all Hypnotics is to be used, it should be used only for a short time since Long acting hypnotics may produce hangover AND Hypnotics used for a long time may worsen the clinical status of the patient.

PROGNOSIS-

- Treatment response depends upon the etiology of insomnia.

- Rebound insomnia may follow abrupt withdrawal of sedative hypnotic medication.

- Some patients may respond to nondrug measures once the problem is discussed.

HOMOEOPATHIC REMEDIES-

Remedies commonly used for sleeplessness due to physical causes -

1) Cinchona-

A/F exhausting diseases,
Loss of vital fluids especially haemorrhages, excessive lactation, diarrhoea, suppurations,
Unrefressing sleep or constant stupor,
Wakes up early << at 3 Snoring especially in children.
Dreams anxious frightful and confused state after waking so that the dream cannot be forgotten nor can be remembered completely.
Mind indulges in castle building.
Mentally indifferent, gloomy.
No desire to live but lacks courage to commit suicide.

2) Chamomilla-

Persons especially children with brown hair, nervous excitable temperament.
Children, newborn and during dentition.
Sleeplessness due to pain.
Drowsiness with moaning Weeping during sleep.
Anxious frightful dreams.
Half open eyes. Restlessness
Oversensitive to pain and irritability.
Snappish, cannot answer politely.
Child wants many things which he refuses when he gets it.
Child quiet only when carried in arms.
MENTAL CALMNESS IS CONTRAINDICATION OF CHAMOMILLA.

3) Belladonna-

Sleeplessness due to congestion of brain which also leads to furious excitement, perverted mental state
Twitching convulsions, pain.
Talking screaming, starting in sleep.
Restless sleep, crying out kept awake by pulsations of blood vessels.
Starting when closing the eyes or during sleep.
Sleepy but cannot sleep.
Sleeps with hand under head
<< noise,touch, lying down.
Acuteness of all senses,
Hallucinations, sees monsters and hideous faces.
Mentally violent, bites, strikes,desire to escape.

4) Arnica-

Sleepless from overexertion.
Restlessness. Comatose drowsiness.
Awakens with hot head, coldness of lower part.
Everything on which he lies seems too hard,
Complaints constantly of it and keeps moving from place to place in search of soft spot.
Dreams of death, mutilated bodies.
Anxious terrible dreams,horrors in night.
Involuntary stools during sleep.

Remedies for sleeplessness due to mental causes -

Coffea, Passiflora, Aquileg, Ambra Gresia, Ignatia Hyocyamus

1) Coffea Cruda -

Suits all, lean stooping person, dark complexion.
A/F excitement of any kind good news or joys, night watching, unsuitable diet, overcrowding of ideas.
Sleepless, wide awake condition, impossible to close the eyes. Physical excitement through mental exaltation
Unusual activity of mind and body, full of ideas, quick to act.
Over sensitiveness of all special senses.
Sleeps till 3 a.m. after which there is only dozing.
Sleep disturbed by dreams.
Mentally person is irritable and excited.
Tosses about in anguish

2) Passiflora -

Especially suited in infants and aged.
Sleeplessness from mental irritation or pain.
This drug induces sleep as it has quieting effect on nervous system. Restless and wakeful resisting from exhaustion.
Insomnia due to mental worry and overwork with tendency to convulsion.

3) Aquilegia -

Remedy for sleeplessness due to hysteria,
Hysteria at climaxis (menopause).
Nervous trembling of body.
Sensitive to light and noise.

4) Ambra Grisea -

Especially for young girls who are excitable nervous and weak or old people with nervous affections,
Thin lean personality.
A/f worry and business troubles.
Cannot sleep from worry or business embarrassment, must get up. Anxious dreams.
Coldness of body and twitching of limbs during sleep.
Mentally there is dread of people and desire to be alone.
Cannot do anything in presence of others,
Cannot even pass stool or urine in their presence.
Shy,Flushes easily.
Music causes weeping.
Despair. Loathing in life.
Time passes slowly for them.
Brooding on unpleasant things in past or present.

5) Ignatia -

Especially suited to nervous temperament,
women of sensitive easily excited nature, dark hair skin mild disposition.
Sleeplessness from unpleasant news,
Suppressed mental suffering, shame, mortification, cares.
Jerking of single limbs or whole body on going to sleep.
Itching of arms and violent yawning.
Dreams continuing for long time troubling the person.
Mentally moods change rapidly in a very short time from joy to sorrow or laughing to weeping.
Involuntary sighing, Desire to be alone.
Impatient irresolute and quarrelsome.
Contradiction excites anger. Easily offended.
Cannot weep in front of others.

6) Hyocyamus-

Sleeplessness from nervous excitement with bewildering ideas and images. Intense sleeplessness.
Convulsions. Start up frightened.
There is a perfect picture of mania of quarrelsome and perverted character.
Immodesty in acts, gestures and expressions is a characterestic of this remedy.
Talkative and persist in undressing herself or uncovering genitals. Mentally patient is jealous afraid of being poisoned, suspicious. Great hilarity. Inclined to laugh at everything. Deep stupor.

BIOCHEMIC REMEDIES

1) Kali Phos -

Nervous irritability.
Patient is always thinking about the routine worries.
(Intellectual work related worries.)
Excellent nerve remedy.
Causing fatigue and mental tiredness.
Especially suited to children who are studying hard during exams of school and college with tired feeling.
Fear of failure causing sleeplessness.
Sleepy but cannot sleep.

2) Nat Mur -

Brooding tendencies about emotional disturbances causes sleeplessness.
Weeps alone in bed at night, remembering the unpleasant evening. Nervous irritability with high salt intake.
Dwells on past disagreeable events in the life.
Eyes remain open throughout the night.

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